RISK OF LIVER-DISEASE IN HCV-SEROPOSITIVE KIDNEY-TRANSPLANT RECIPIENTS

Objective This study determined whether renal allograft recipients wit h antibodies to hepatitis C virus (HCV) at the time of transplantation experienced increased morbidity or mortality from hepatitis, liver di sease, or hepatocellular carcinoma compared with patients without anti -HCV. Summary Background Data Chronic liver disease is a cause of sign ificant morbidity and mortality after kidney transplantation and the c ontribution of HCV to this problem has not been determined. The recent characterization of the HCV genome has resulted in the development of screening tests for antibody to HCV, allowing the identification of e nd-stage renal disease patients with anti-HCV who are candidates for t ransplantation. The risk to these patients for the development of hepa tic complications after subsequent transplantation is unknown.Methods Archived sera obtained from 163 kidney transplant recipients at the ti me of transplantation were tested for anti-HCV using the Abbott HCV 2. 0 second-generation test system. Sera containing anti-HCV were further analyzed for reactivity against specific HCV recombinant proteins, in cluding core, NS3 (c33c), and NS4 (c100-3), to determine whether a pat tern could be identified in patients with hepatic complications. The f ollow-up of all patients was current (mean length of follow-up was 33 months) to identify patients with hepatic complications. All patients had previously been tested for HBSAg. Results Twenty-nine patients (18 %) had anti-HCV and three (1.8%) had HBSAg. Forty-five patients (28% o f total) had transient elevations of AST or ALT without subsequent evi dence of liver disease. Three patients had a syndrome of acute hepatit is. Chronic liver disease developed in only six patients (3.6%) after transplantation. Four had anti-HCV only, one had HBSAg only, and one w as positive for both. However, of the 29 patients with anti-HCV, chron ic liver disease developed in 5 (17%), including 1 patient who was pos itive for HBSAg. No patient had hepatocellular carcinoma. Conclusions Pertubations of liver function were common in the kidney transplant re cipients studied, most were self-limited, and few were associated with evidence of viral hepatitis. The risk of developing chronic liver dis ease after transplantation of patients with anti-HCV was significant ( p < .008 using Fisher's exact test) compared with absence of anti-HCV. No consistent pattern of reactivity to the various HCV proteins could be identified in the patients who developed hepatic complications.